- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,786.30 / $11,748.98
| Facility | | $1,122.02 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,471.29 / $22,908.68
| Facility | | $3,548.13 | $10,471.29 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,187.76 / $5,495.41
| Facility | | $977.24 | $2,187.76 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |